Allan Powell: "Blood Medicine" is a study in human greed

July 26, 2013

Author Kathleen Sharp is very deserving of the plaudits for her masterful portrayal of a complicated and controversial subject. Indeed, one critic rated “Blood Medicine” to be the “best nonfiction book of the past 20 years.” Yet, this book reads more like a Charles Dickens novel with its abundant cast of failed human beings. There are few heroes in this sordid story of so many members of the medical profession who gave way to material gain at the expense of ethical judgment.

The medicine of interest was epo (epoetin alpha), marketed under several trade names, one of which is Procrit and sold by Ortho Biotech, a unit of J&J (Johnson & Johnson). The author regards this highly acclaimed medical miracle as “one of the deadliest prescription drugs ever.” Several studies of this drug would seem to support this charge.

The leading character in this tragicomedy is Mark Duxbury, whose career as a salesman of Procrit would be too incredible for even Dickens to include in one of his novels. Duxbury was a very able representative of Procrit, winning several awards as a leading salesman. One of his most prized possessions was a gold ring presented for one year of banner sales.

Gradually, as Duxbury became aware of studies revealing the negative results of using Procrit and specific cases of fatalities, he became alarmed at the downside of this drug. He made the mistake of openly airing his concern along with several business practices he thought to be questionable. Giving physicians huge fees for speaking at conventions and conferences were clear conflicts of interest. Duxbury regarded the practice of promoting Procrit using claims beyond those permitted on the label to be illegal.

Such comments by an employee, even a top salesman, were unacceptable and management struck back with a vengeance. Two of Duxbury’s supervisors took turns in making life miserable. The idea was to torment Duxbury enough that he would give up and leave the firm. The constant tension drove him to counseling. She diagnosed the situation to be a case of corporate “gaslighting.” The term came from the 1944 film “Gaslight,” in which a scheming husband plotted to drive his wife insane as a means to get her confined to an asylum and pave the way to get her wealth.

Eventually, Duxbury was fired. He retaliated with a series of legal suits charging unlawful termination, breach of contract and other complaints. He was unsuccessful in these legal bouts and his financial and physical conditions were deteriorating rapidly. By a stroke of good fortune, Duxbury met an astute lawyer, Jan Schlichtmann, who entered a whistleblower suit in a lower court. This, too, failed and the case went to a higher court of appeal. To their shock, they were finally successful.

Unfortunately, soon after this surprise victory, Duxbury died suddenly — voiding any opportunity to realize any of the benefits that might have come to one involved in such a huge and significant case. One can only marvel how a drug with so many known dangers could escape proper regulatory restraints. Duxbury offers the simple response that it was the clout derived from a company marketing a product earning $100 billion in annual global sales.

The sorry record of Procrit was clear from the beginning when five Dutch cyclists, then a Belgian and then seven more Dutch cyclists died when they used the drug as an endurance booster. Years later, while the last trial was in progress, a very damaging report declared, “Procrit triggered blood clots, strokes, heart attacks and deaths in patients with chronic renal failure, on chemotherapy and even surgical candidates.” Again, why the reluctance to restrain Procrit?

Duxbury sincerely believed that the drug companies selling Procrit were guilty of serious moral and legal infractions and that “somebody needs to be held accountable.” Due to his strong conviction, he literally gave his life to bring these greedy and uncaring culprits to justice. He followed a maxim given by a friend. “The secret of life was to have a task, something you devote your entire life to … something you bring everything to every minute of the day. ... And the most important thing is it must be something you cannot possibly do.” Duxbury was able to realize a bit of each of the elements in this maxim. He deserved better.

Allan Powell is a professor emeritus of philosophy at Hagerstown Community College.